SA Fam Pract 2004;46(6) 38
Diabetes Mellitus Type 2
Diagnosis of Type 2
Address other risk factors
Lifestyle modifications as part of initial management
Disease identification card or
disc recommended Measure HbA1c every 3 months depending
on control and changes in therapy
Target HbA1c should be ≤ 7.0%
Have lifestyle modifications been successful?
NO
Consider oral hypoglycaemic agents Is there renal and/or cardiac dysfunction
YES
Continue to monitor HbA1c every 6 months
YES
Consider sulphonylurea
NO
Is Patient’s BMI > 25?
YES
Use metformin
NO
Consider either metformin or a sulphonylurea depending on plasma glucose
Adequate control?
NO
Optimise dose of oral hypoglycaemic agent
YES
Continue to monitor blood glucose and HbA1c 3-6 monthly
Adequate control?
NO If patient on metformin
consider adding a sulphonylurea
If patient on sulphonylurea and has normal renal function and has no cardiac dysfunction
add metformin If poor renal function:
Consider adding a thiazolidinedione or insulin.
YES Continue to monitor
blood glucose and HbA1c 3-6 monthly
Is control adequate?
YES
Monitor HbA1c every 3 to 6 months
NO
Consider adding / enhancing insulin therapy
Chronic disease list algorithms
The new Medical Schemes Act requires that chronic diseases be diagnosed and managed according to the prescribed therapeutic algorithms for the condition, published by the Minister of Health.
Algorithms for the 25 conditions on the chronic disease list are available at http://www.medicalschemes.com.
This algorithm is reproduced with the kind permission of the Council for Medical Schemes.
Glossary:
• HbA1c – Glycosylated hemoglobin
• BMI – Body mass index Applicable ICD 10 Coding:
• E11 Non-insulin-dependent diabetes mellitus - E11.0 Non-insulin-dependent diabetes
mellitus with coma
- E11.1 Non-insulin-dependent diabetes mellitus with ketoacidosis
- E11.2 Non-insulin-dependent diabetes mellitus with renal complications - E11.3 Non-insulin-dependent diabetes
mellitus with ophthalmic complications - E11.4 Non-insulin-dependent diabetes mellitus with neurological complications - E11.5 Non-insulin-dependent diabetes mellitus with peripheral circulatory complications
- E11.6 Non-insulin-dependent diabetes mellitus with other specified complications - E11.7 Non-insulin-dependent diabetes mellitus with multiple complications - E11.8 Non-insulin-dependent diabetes mellitus with unspecified complications - E11.9 Non-insulin-dependent diabetes
mellitus without complications
• E12 Malnutrition-related diabetes mellitus - E12.0 Malnutrition-related diabetes mellitus
with coma
- E12.1 Malnutrition-related diabetes mellitus with ketoacidosis
- E12.2 Malnutrition-related diabetes mellitus with renal complications
- E12.3 Malnutrition-related diabetes with ophthalmic complications
- E12.4 Malnutrition-related diebetes mellitus with neurological complications
- E12.5 Malnutrition-related diabetes mellitus with peripheral circulatory complications - E12.6 Malnutrition-related diabetes mellitus with other specified complications - E12.7 Malnutrition-related diabetes mellitus
with multiple complications
- E12.8 Malnutrition-related diabetes mellitus with unspecified complications
- E12.9 Malnutrition-related diabetes mellitus without complications
• O24 Diabetes mellitus in pregnancy
- O24.1 Pre-existing diabetes mellitus, non- insulin-dependent
- O24.2 Pre-existing malnutrition related diabetes mellitus
- O24.3 Pre-existing diabetes mellitus, unspecified
Note:
1. Medical management reasonably necessary for the delivery of treatment described in this algorithm is included within this benefit, subject to the application of managed health care interventions by the relevant medical scheme.
2. To the extent that a medical scheme applies managed health care interventions in respect of this benefit, for example clinical protocols for diagnostic procedures or medical management, such interventions must -
a. not be inconsistent with this algorithm;
b. be developed on the basis of evidence-based medicine, taking into account considerations of cost-effectiveness and affordability; and c. comply with all other applicable regulations made in terms of the Medical Schemes Act, 131 of 1998.
3. This algorithm may not necessarily always be clinically appropriate for the treatment of children.
If this is the case, alternative paediatric clinical management is included within this benefit if it is supported by evidence-based medicine, taking into account considerations of cost-effectiveness and affordability.
CDL - guidelines at a glance
© Council for Medical Schemes
